Learning points and OSCE

Learning points-

1.The importance of history taking 

2.The importance of past history which might be the cause for the present condition
 
3.The effect of rat poisoning on the kidney

4.The types of rat poisoning that are commonly available 

 5.The importance of building proper relationship between the patient and the doctor 

OSCE-
Mechanisum of ascitis-
It is associated with profound changes in the splanchnic and systemic circulation and with renal abnormalities. The development of ascites is related to the existence of severe sinusoidal portal hypertension that causes marked splanchnic arterial vasodilation and a forward increase in the splanchnic production of lymph. Splanchnic arterial vasodilation also produces arterial vascular underfilling, arterial hypotension, compensatory activation of the RAAS, SNS, and AVP, and a continuous sodium and water retention, leading to ascites formation. Now, therefore, the splanchnic arterial circulation, rather than the venous portal system, is believed to be involved in the pathogenesis of ascites formation.

Reference-https://pubmed.ncbi.nlm.nih.gov/11232200/#:~:text=The%20development%20of%20ascites%20is,the%20splanchnic%20production%20of%20lymph.

Medical management of ascitis-

Patients with ascites and hyponatremia may be treated with aquaretics—vasopressin V2-receptor antagonists that promote excretion of electrolyte-free water. Tolvaptan has been approved by the FDA for treating hypervolemic hyponatremia in ascites. Conivaptan has been approved by the FDA for treating hypervolemic hyponatremia in syndrome of inappropriate antidiuretic hormone

Shunt treatment os ascitis-

The transjugular intrahepatic protosystemic shunt  is an interventional radiologic technique that reduces portal pressure and may be the most effective treatment for patients with diuretic-resistant ascites.



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